From the Guidelines
For most people with atopic dermatitis (AD), emollients and prescription topical therapies are sufficient to achieve AD control, but for those with more severe or widespread AD, phototherapy or systemic therapies may be considered to improve disease control and quality of life (QOL) 1.
Management of Atopic Dermatitis
When managing atopic dermatitis, it's essential to consider the severity of the disease, its impact on the patient, and the efficacy, safety, and accessibility of available interventions.
- For mild cases, using over-the-counter 1% hydrocortisone cream applied thinly to affected areas twice daily for up to 7 days, along with daily moisturizing using fragrance-free products, may be sufficient.
- For moderate to severe cases, prescription-strength topical steroids such as triamcinolone 0.1% cream twice daily for 1-2 weeks may be necessary.
- Oral antihistamines like cetirizine 10mg daily can help control itching.
- Avoid known triggers including harsh soaps, fragrances, and irritating fabrics.
- Take short, lukewarm showers and apply moisturizer immediately afterward while skin is still damp.
Consideration of Allergic Contact Dermatitis
It's also important to consider the possibility of allergic contact dermatitis (ACD), which can manifest as eczematous lesions and may be clinically indistinguishable from AD 1.
- ACD can be diagnosed through patch testing, which involves placing suspected allergens on unaffected skin for 48 hours.
- Common contact allergens in AD patients include nickel, neomycin, fragrance, formaldehyde, and other preservatives.
- Avoidance of the suspected allergen with resolution of the corresponding dermatitis confirms the diagnosis of ACD.
Decision to Initiate Advanced Therapies
The decision to initiate phototherapy or systemic therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of AD, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
- Systemic therapies considered in these guidelines include oral medications (immunosuppressants, corticosteroids, antimetabolites, Janus kinase [JAK] inhibitors) and injectable medications (biologics).
- The use of evidence-based topical therapies, including emollients and topical anti-inflammatory medications, concomitantly with phototherapy and systemic therapies, is also recommended.
From the FDA Drug Label
CLINICAL STUDIES Three randomized, double-blind, vehicle-controlled, multi-center, Phase 3 studies were conducted in 589 pediatric patients ages 3 months-17 years old to evaluate ELIDEL ® (pimecrolimus) Cream 1% for the treatment of mild to moderate atopic dermatitis Two of the three trials support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis At endpoint, based on the physician’s global evaluation of clinical response, 35% of patients treated with ELIDEL Cream were clear or almost clear of signs of atopic dermatitis compared to only 18% of vehicle-treated patients.
The pimecrolimus (TOP) cream is used for the treatment of mild to moderate atopic dermatitis.
- Key benefits of using pimecrolimus cream include:
- Reduction in signs of atopic dermatitis
- Improvement in pruritus
- Efficacy results show that 35% of patients treated with ELIDEL Cream were clear or almost clear of signs of atopic dermatitis at endpoint, compared to 18% of vehicle-treated patients 2.
From the Research
Definition and Treatment of Dermatitis
- Dermatitis, also known as atopic dermatitis (AD), is a chronic inflammatory skin disease characterized by extreme pruritis and lichenified papules and plaques that may begin in or persist into adulthood 3.
- The mainstay treatment for patients with AD is topical therapies, which are used not only by mild patients but also by moderate-to-severe patients, in conjunction with systemic treatment 4.
Topical Corticosteroids and Calcineurin Inhibitors
- Topical corticosteroids (TCS) are a mainstay of treatment for atopic dermatitis (AD), but their use is limited due to adverse events, such as skin thinning, and the potential for impairing the skin barrier 5, 6.
- Topical calcineurin inhibitors (TCI) provide effective AD treatment without impairing the skin barrier or inducing skin thinning, and may have a particular use in thin and sensitive skin areas 5, 6.
- Tacrolimus had statistically significant improvement in disease severity compared with TCS in 4 of the 5 studies that compared tacrolimus with weak TCS 6.
Safety and Efficacy of Topical Calcineurin Inhibitors
- Topical calcineurin inhibitors have been shown to be a safe and effective alternative to topical corticosteroids in almost 7 million patients 7.
- None of the topical calcineurin inhibitors have been associated with systemic immunosuppression-related malignancies known to occur following long-term sustained systemic immunosuppression with oral immunosuppressants 7.
- Preclinical and clinical data suggest a greater skin selectivity and larger safety margin for topical pimecrolimus 7.